Doctor standards well maintained

Is it realistic to expect every single doctor is up to
the job? The Dunedin-based chairman of the Medical Council, Dr
John Adams, does not think so.

''Is every doctor in New Zealand competent? Well, no, and how
could we expect that with 12,500 doctors on the
register?''''Do we do all that we can to deal with the issues
of competence when they arise and come to our attention?
Yes,'' Dr Adams said.

Prompted by medical scandals, from last month doctors in the
United Kingdom face a stringent new regime requiring them to
demonstrate they are fit to practise.

Responsible officers would recommend every five years whether
the doctor should be recertified. Doctors must maintain a
portfolio of evidence supporting their credentials, including
patient feedback, and have an annual assessment. The chief
executive of the UK's General Medical Council, Niall Dickson,
described it as the biggest change in British medical
regulation for more than 150 years.

Dr Adams said for the foreseeable future ''continuing
professional development'' (CPD) programmes will remain at
the core of New Zealand's doctor recertification programme''.

The regulatory authority urged the sector to act promptly and
notify it about problem doctors, he said. The UK's new regime
looked potentially cumbersome, resource-intensive and
bureaucratic, but he would monitor its progress.

New Zealand doctors were not lightly regulated, he argued,
saying the various CPD programmes were rigorous. Many
professional colleges stipulated higher CPD requirements for
their members than the council required. Since last year, in
a big step, general registrants have been subject to tougher
requirements, including three-yearly practice visits.

However, the new system was not about weeding out incompetent
doctors.

''This process is not about finding the doctors who are not
performing.''

It was about helping doctors and giving feedback, from which
competency matters might arise.

The change was not greeted with ''universal delight'' by
general registrants, who are not vocationally registered.
While at times it was necessary to ''drag [the profession]
kicking and screaming'', good medical regulation relied on
working with the profession. Otherwise, if doctors relied on
an outside entity telling them what to do, they would take
less responsibility.

''We have to engage the profession.''

Former health and disability commissioner Prof Ron Paterson's
book, The Good Doctor, released last year, criticised New
Zealand's medical regulations as too light-handed and lacking
transparency. While much of the book was ''terrific'', Dr
Adams did not agree with all of Prof Paterson's
prescriptions.

When contacted, Prof Paterson said Dr Adams' acknowledgement
not all doctors were competent was ''refreshingly honest''.

However, that state of affairs should not be accepted; the
public did not want to take ''pot luck''. He believed
Britain's new system was not overly bureaucratic, but had the
rigour the New Zealand public tended to falsely believe
applied here.

He favours a tougher recertification programme with practice
reviews, annual assessments, and more stringent CPD
programmes. CPD programmes tended to measure activity, rather
than competence, and should be tightened up. He was pleased
with the move to tighten regulations for general registrants,
a group that attracted many complaints during his time as
health and disability commissioner. This had not been easy
for the council, which had demonstrated it saw its role as a
regulator, not a professional body, which was encouraging.

''The council's in a difficult position. Council's got this
role of protecting the public, but they also need to sell it
to the profession. I can understand it being presented as
quality assurance and improvement.''

Decent recertification programmes identified the ''bad
apples'' and improved quality, not one or the other.

Even though Britain's regime was sparked in part by the
murderous Dr Harold Shipman, the new system would probably
not weed out another ''pathological killer''. However, it
would be sufficient to prevent other scandals that had caused
community outrage. It would put the UK ahead of most of the
world, including New Zealand.

New Zealand had a culture of ''exporting'' doctors around the
health system, which had to stop.